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South Dakota rates for HCPCS L0700

Cervical-thoracic-lumbar-sacral orthosis (CTLSO), anterior-posterior-lateral control, molded to patient model, (Minerva type)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,666.60 / $1,666.60 / $1,666.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.09 / $1,666.60 / $1,907.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,703.99 / $1,703.99 / $3,340.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,780.63 / $2,808.43 / $3,475.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,075.31 / $2,833.07 / $11,712.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.94 / $1,468.70 / $2,997.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,777.59 / $3,340.52 / $4,370.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,614.53 / $3,387.54 / $6,383.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,921.96 / $2,250.13 / $2,674.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.70 / $1,325.67 / $2,398.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,976.10 / $2,976.10 / $2,976.10